The network just acknowledged that the pervasive and convenient belief about pills is wrong. As we have written numerous times, it is fentanyl—an "opioid on steroids"—that is the culprit.

About 75 percent of the state's men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015. It's a pattern cities and towns are seeing across the state and country, particularly in New England and some Rust Belt states.

Martha Bebinger writing for CNN. April 11, 2017

The evidence has been clear for years. When pills become scarce, addicts turn to heroin, which now often contains fentanyl (see Fig. 1). A 2014 study found that 94 percent of heroin users said that they switched to heroin because the pills became “far more expensive and harder to obtain.” (1)

Fig. 1- Once OxyContin - the primary driver of opioid addiction - was finally reformulated in 2010 to make it much harder to abuse, it's use plummeted, while at the same time, heroin use soared.

Overdose deaths in New Hampshire, 2011-2016. Source: Office of the medical examiner

The picture above shows what is really happening. In 2011, only three percent of overdose deaths in the state were due to fentanyl alone, and another eight percent were from fentanyl plus another drug (other than heroin). Heroin, either alone or in combination with drugs other than fentanyl was responsible for 28 percent of overdose deaths.

But in 2016, the story was very different. Fentanyl (alone) caused 27 percent of overdose deaths, and when combined with other drugs, that number became 70 percent. During this same time, the incidence of heroin-related deaths (excluding fentanyl) plummeted from 28 percent to three percent. Within just five years, the two drugs traded places. The magnitude of this change reflects the extent of penetration of fentanyl into the US. At least in New Hampshire, fentanyl has essentially wiped out the heroin market.

Even though the incidence of pill-only deaths (17 percent) is relatively low, this number is nonetheless inflated. Forty-three percent of opioid pill deaths nationwide are due to a combination of the opioid plus a benzodiazepine, such as Valium (2). So the actual incidence of pill-only deaths (assuming that the national figures apply to those of New Hampshire) would be 9 percent, and probably less (3). This is shown in Figure 2.

Fig. 2 Total national overdose deaths from opioid pills (left). The involvement of benzodiazepines in opioid deaths (right). Source: NIH

The "pills kill" narrative we constantly hear is false. At least in New Hampshire, pills are not the main problem (4). Fentanyl is, which became popular only after the pills were harder to get—as good an example of the law of unintended consequences as you'll ever see.

Which makes me wonder if the state should change its motto: Live Pill Free or Die?

The false narrative about the dangers of opioid pills has us looking at the wrong villain, and the consequences of this error are terrible. People with a legitimate need for pain drugs are terrified about being cut off from their medicines, while the real monster just sits and laughs at us.

Next: The second false narrative - the myth of addiction from legitimate use of prescribed opioid drugs.

Notes:
(1) See: Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–826. doi:10.1001/jamapsychiatry.2014.366.Notes:

(2) The combination of an opioid plus a benzodiazepine is not only more dangerous than either alone, but is more so than a simple addition of each drug's independent risk. There is a pharmacological synergy between the two.

(3) Opioid pills are also consumed with other drugs, such as alcohol and cocaine. It is all but certain that the 9 percent figure for opioid-only deaths is inflated.

(4) Very similar numbers can be found in Department of Health reports from a number of states, including Florida, Ohio, Pennsylvania, and Massachusetts. This is not a New Hampshire problem.

Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. The field of drug discovery involves chemistry, biochemistry, toxicology, and pharmacology - skills that he has used to write on a wide variety of topics since he joined ACSH in 2010. One of the topics he has tackled is the so-called "opioid crisis." He is now recognized as an expert in this area and was the first journalist to write a nationally published opinion piece about the unintended consequences of a governmental crackdown on prescription pain medications (New York Post, 2013). Since that time he has published more than 20 op-eds in regional and national newspapers on different aspects of the crisis. In that same year, he testified at an FDA hearing, where he noted that fentanyl was the real danger, something that would be proven years later. At that time almost no one had heard of the drug.

He was also the first writer (2016) to study, dissect and ultimately debunk the manipulated statistics used by the CDC to justify its recommendations for opioid prescribing, which have resulted in Draconian requirements for prescribing pain medications as well as government-mandated, involuntary tapering of patients receiving opioid treatment, both of which have caused great harm and needless suffering to chronic pain patients. His 2016 article, "Six Charts Designed to Confuse You," is the seminal work on CDC deception and has been adopted by patient advocacy groups and individuals and has been sent to governors and state legislatures.

Dr. Bloom earned his Ph.D. in organic chemistry from the University of Virginia, followed by postdoctoral training at the University of Pennsylvania. His career in drug discovery research began at Lederle Laboratories, which was acquired by Wyeth in 1994, which itself was acquired by Pfizer in 2009. During this time he participated in research in a number of therapeutic areas, including diabetes and obesity, antibiotics, HIV/AIDS, hepatitis C, and oncology. His group discovered the novel antibiotic Tygacil®, which was approved by the FDA for use against resistant bacterial infections in 2005. He is the author of 25 patents, and 35 academic papers, including a chapter on new therapies for hepatitis C in Burger’s Medicinal Chemistry, Drug Discovery and Development, 7th Edition (Wiley, 2010), and has given numerous invited lectures about how the pharmaceutical industry really works.

Dr. Bloom joined the American Council on Science and Health in 2010 as ACSH’s Director of Chemical and Pharmaceutical Sciences, and has since published more than 60 op-eds in numerous periodicals, including The Wall Street Journal, Forbes, New Scientist, The New York Post, National Review Online, The Boston Herald, and The Chicago Tribune, and given numerous radio and television interview on topics related to drugs and chemicals. In 2014, Dr. Bloom was invited to become a featured writer for the site Science 2.0, where he wrote more 75 pieces on a broad range of topics.

We are funded mostly by readers like you. Please consider donating!

"Big Fears Little Risks" is a documentary, but unlike most of what you see on places like Netflix, it is pro-science, and not scaremongering trace chemicals, food, or the modern world. We instead are going to take back the discourse from trial lawyers and the trade groups they use to profit from fear.

The American Council on Science and Health is a research and education organization operating under Section 501(c)(3) of the Internal Revenue Code. Contributions are fully tax-deductible. ACSH does not accept government grants or contracts, nor do we have an endowment. We raise our funds each year primarily from individuals and foundations.